Clinical Value Of Contrast Enhanced Ultrasound In Biliary Tract Obstruction

Part one The value of routine ultrasound in localization and qualitative diagnosis of biliary obstructive diseasesObjective To compare the range,degree and image features of biliary dilatation in patients with biliary tract obstruction in different locations by conventional ultrasound,and to explore the positioning and qualitative diagnostic value of conventional ultrasound in biliary tract obstruction by combining the relationship between the occurrence of jaundice and biliary tract dilatation.Methods Retrospectively collected the clinical examination information of 213patients with clinically or pathologically confirmed biliary obstructive disease,the internal diameters of intrahepatic and extrahepatic bile ducts measured by conventional ultrasound,the length of the displayed segment of extrahepatic bile duct and the image characteristics.Patients were divided into high obstruction,middle obstruction and low obstruction,and the proportions of different sites and etiology were compared.The degree,range and length of bile duct dilatation in patients with obstruction at different sites were analyzed,and the similarities and differences were compared by ANOVA.The relationship between jaundice and ultrasonographic bile duct dilatation was analyzed.At the same time,according to the image features of the lesion,such as size,shape,echo,boundary,internal blood flow,relationship with bile duct wall,hilar and peripancreatic lymph node enlargement,qualitative diagnosis of the lesion was made,and the qualitative accuracy,positive rate,negative rate,sensitivity and specificity of conventional conventional ultrasound for different obstruction sites were calculated.Results Among 213 patients with biliary tract obstruction,high and low obstruction accounted for 33.3%and 53.5%,respectively,while the median obstruction only accounted for 13.2%.Portal cholangiocarcinoma(23.9%),subcommon bile duct calculi(14.6)and pancreatic cancer(13.6%)were the top three causes of obstruction.There was no significant difference in the diameter of intrahepatic dilated bile duct between different sites(F=0.60,P>0.05).There were significant differences in the inner diameter of extrahepatic dilated bile duct among all groups(F=8.86,P<0.05),and between low and middle obstruction,as well as between low and high obstruction(P<0.05),but no significant differences between high and middle obstruction(P>0.05).There were statistically significant differences in jaundice symptoms among patients with obstructive biliary tract disease with different biliary dilatation ranges(c2=55.0,P<0.05).There was significant difference in the length of extrahepatic bile duct in different parts(F=55.9,P<0.05).The positive rate(98.3%),sensitivity(86.8%)and coincidence rate(85.9%)of conventional ultrasonography for high obstruction were higher than those for medium obstruction(50.0%、55.6%、64.3%)and low obstruction(80.0%、69.8%、59.6%),and the negative rate(18.2%)and specificity(66.7%)of high obstruction were lower than those for medium obstruction(77.8%、73.7%)and low obstruction(67.8%、78.4%).The qualitative coincidence rate of ultrasonography for biliary tract obstruction in different locations decreased layer by layer from high to low.Conclusion Routine ultrasonography is of great value in the localization and characterization of biliary tract obstruction in different sites,and is also of great significance in the screening of some patients with early biliary tract obstruction.Part two To explore the clinical value of double contrast enhanced ultrasound in PTCD in patients with biliary obstructionObjective To explore the clinical value of double contrast enhanced ultrasound(D-CEUS)in percutaneous transhepatic cholangial drainage(PTCD)in patients with biliary obstruction.Methods All 29 patients with biliary obstruction underwent catheterization and drainage under the guidance of conventional ultrasound(US).Among them,15patients underwent D-CEUS,which includes transvenous contrast enhanced ultrasound(CEUS)and ultrasonic cholangiography(USC),were set as group B(experimental group),postoperative drainage and poor yellow reduction were guided by D-CEUS;the remaining 14 patients were set to group A(blank group)without other operations.Try to evaluate the clinical significance of D-CEUS in catheterization and drainage of patients with biliary obstruction.Results The bile drainage volume of patients in group A was lower than that of group B at 1,3,and 7 days after receiving biliary drainage,and the difference between the two groups was statistically significant(F=16.085,P<0.05).The total bilirubin,γ-glutamyltransferase,and alanine aminotransferase in group A were higher than those in group B,and the difference between the two groups was statistically significant(P<0.05).There were 5 patients in group A who failed to insert the tube and the position of the tube was poor(5/14(35.71%)),and all 15 patients in group B were successful in one-time catheterization(15/15(100%)),and the difference between the two groups was statistically significant(c~2=8.413,P<0.05).Six patients in group A had postoperative complications,and there was only one patient in group B,and the difference between the two groups was statistically significant(c~2=5.585,P<0.05).Conclusion D-CEUS can effectively perform preoperative lesion assessment,intraoperative catheter placement navigation,and postoperative auxiliary adjustment for biliary obstruction patients undergoing PTCD,which effectively improving the efficiency of reducing yellowing.Part three Application of double contrast enhanced ultrasound in classification of hilar cholangiocarcinoma and diagnosis of etiology of extrahepatic biliary obstructionObjective To investigate the clinical value of double contrast enhanced ultrasound(D-CEUS)in the classification of hilar cholangiocarcinoma and the diagnosis of extrahepatic biliary obstruction.Methods The data of 114 patients with obstructive jaundice who were examined in the ultrasound department of our hospital from October 2018 to February2020 were retrospectively collected.All patients underwent transvenous contrast enhanced ultrasound(CEUS)before operation,and ultrasonic cholangiography(USC)and three-dimensional ultrasonic cholangiography(3D-USC)via external drainage tubes after surgery,namely D-CEUS.We judged the classification of hilar cholangiocarcinoma and the nature of extrahepatic biliary obstruction based on the characteristics of D-CEUS images.All patients who had received D-CEUS received magnetic resonance cholangiopancreatography(MRCP)and X-ray cholangiography.The classification of hilar cholangiocarcinoma is based on X-ray cholangiography as the gold standard,and the accuracy of US,CEUS,and D-CEUS is analyzed byc~2test.The qualitative analysis of extrahepatic biliary obstruction takes surgical pathology as the gold standard.Thec~2test is used to analyze the diagnostic efficacy of US,CEUS,and D-CEUS.At the same time,receiver operating characteristic(ROC)curves are used to compare the effects of MRI+MRCP and D-CEUS on judging the nature of external biliary obstruction.Results The coincidence rates of conventional ultrasound(US),transvenous contrast enhanced ultrasound(CEUS),and D-CEUS in the classification of hilar cholangiocarcinoma and X-ray cholangiography were:75.6%(34/45)and 82.2%(37/45),93.3%(42/45).The coincidence rates of the judgment of the nature of extrahepatic biliary obstruction and the surgical pathology by US,CEUS,and D-CEUS were 56.5%(39/69),82.6%(57/69),and 85.5%,respectively.(59/69).The ROC curve indicates that the cut-off value of MRI+MRCP classification and D-CEUS classification for diagnosing benign and malignant extrahepatic biliary obstruction are both 2.5,and the area under the curve(AUC)is 0.897(P<0.01)and 0.906(P<0.01),respectively.Sensitivity The specificity and specificity were 77.5%,93.1%and 87.5%,82.8%,respectively.Conclusion D-CEUS is comparable to X-ray cholangiography and MRCP in the diagnosis of hilar cholangiocarcinoma classification and extrahepatic biliary obstruction.It is clinically important in classification of hilar cholangiocarcinoma and extrahepatic biliary obstruction.